The Hidden Value of Baseline Testing Isn't Diagnostic — It's Cultural

Here’s the most surprising finding from our review of the baseline testing research: the greatest value of baseline testing may have nothing to do with diagnostics.

The Salmon 2024 study

A 2024 qualitative study published in the Journal of Science and Medicine in Sport (Salmon et al.) studied the implementation of baseline testing in community rugby organizations in New Zealand. The researchers expected to evaluate diagnostic utility. What they found instead were what they termed “unintended consequences” of the baseline testing process — consequences that may ultimately matter more than any individual test score.

Education that otherwise wouldn’t happen

The testing process created education opportunities that players, coaches, and team managers wouldn’t have otherwise received. Before baseline testing was introduced, many participants had limited understanding of concussion symptoms, reporting protocols, or recovery timelines. The testing session became a natural education session — not through a lecture, but through the experience of taking the test itself and the conversations it generated.

Awareness and trust ripple outward

Baseline testing built concussion awareness across entire organizations, not just among the athletes being tested. Coaches who observed the testing process gained a new appreciation for the seriousness of concussion and the complexity of brain function. Parents who consented to their children’s testing engaged with concussion information that registration packets and policy documents had failed to convey.

The presence of a baseline testing program improved perceptions of safety culture within organizations. Athletes and parents reported feeling that their organization “took brain injuries seriously” — a perception that influenced trust, participation decisions, and willingness to report symptoms.

Normalizing disclosure

And perhaps most importantly, the normalization of baseline testing normalized the act of reporting symptoms and disclosing injuries. In youth sports, where underreporting of concussions remains epidemic — studies published in the Clinical Journal of Sport Medicine suggest that up to 50% of concussions go unreported — this cultural shift may ultimately save more brains than any diagnostic comparison ever could.

What we see on the ground

At Headquarters, we see this cultural effect in every school and organization we work with. The baseline testing session is an education session. The data collection is a conversation starter. The follow-up is a relationship builder. The diagnosis, when it happens, is better because of everything that preceded it. For the companion evidence review, see the great baseline debate.

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